Laserfiche WebLink
May 21 19 , 04 . 49p p . 12 <br /> San .Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton , California 95205-6232 <br /> Telephone: (209) 468- 3420 Fax: (209 ) 4068-3433 Web: www. sjgov.oralehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply' in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department (EHD) address <br /> at the top of this form within 30 days of receipt of the Inspection Report, HSC 25404. 1 .2(c)(1 ) <br /> All correr_tions to other violations noted in the attached Inspection Report (IR) or Continuation Form , or disputes to any <br /> violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report . HSC 25185(c)(3) <br /> Note : All EHD staff time associated with Wiling to comply by the above noted dates will be <br /> billed at the current hourly rate, <br /> For this certification to be complete , the operator of the site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resuitsimanifestsltraining records/other appropriate paperwork, andlor photos verifying <br /> corrections <br /> Inspection Date: April 09 , 2019 Inspected By: STACY RIVERA <br /> Facility Andress: 18806 N LOWED SACRAMENTO RD , W001 CERS ID: 10181237 <br /> I certify under penalty of law that: <br /> 1 . I have corrected the violations specified in the Inspection Report from the above- mentioned inspection date . <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate , and complete: <br /> Photos �Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations . (HSC 25191 ) <br /> Narrte: S& Ifz , c Title:_ OW N e r/ <br /> Signature: _ .,�c , Ct•�� �! Date: s3r - !� <br />